Tag Archives: Health Policy

A “Volatile Marketplace”: Second Quarter Earnings Calls Offer Glimpse of How Insurers Are Faring on ACA Marketplaces—and What 2017 Might Bring

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http://www.commonwealthfund.org/publications/blog/2016/sep/volatile-marketplace?omnicid=EALERT1094761&mid=henrykotula@yahoo.com

This has been a turbulent year for the Affordable Care Act (ACA) marketplaces. As part of our ongoing efforts to better understand how the post-ACA insurance markets are evolving, we reviewed the 2016 second-quarter (Q2) earnings calls and financial filings of several large, publicly traded insurers that participate on the marketplaces: Aetna, Anthem, Centene, Cigna, Humana, Molina, and United.1  While the picture provided by these calls and financial reports is limited – dozens of other participating insurers are not required to report to investors because of their nonprofit or private status – they can help us better understand some of the trends affecting the marketplaces’ stability, including insurer exits from some health insurance marketplaces and increases in 2017 premiums.

 

Chris Van Gorder on the changing face of healthcare

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Scripps Health CEO discusses the changing face of healthcare and his hope for the future.

CEO Power Panel: Are your physicians ready for reform?

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http://www.modernhealthcare.com/article/20160903/MAGAZINE/309039989?utm_campaign=socialflow&utm_source=twitter&utm_medium=social

Modern Healthcare CEO Power Panel

Like it or not, ready or not, MACRA is coming.

Anxiety is rippling through the healthcare industry as the initial reporting period for Medicare’s new payment system for physicians fast approaches. Modern Healthcare’s latest CEO Power Panel survey reveals leaders are bracing for uncertainties and challenges generated by the law, formally titled the Medicare Access and CHIP Reauthorization Act.

This coming phase will be extremely painful for doctors, CEOs worry, even as they applaud the overarching goal of paying for healthcare on the basis of quality over quantity. They are keenly aware of the near-term challenges of managing these growing pains and of successfully mitigating potential negative consequences. But they are also optimistic—even confident—that patients and physicians stand to benefit in the long run.

High-Risk Pools For Uninsurable Individuals

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High-Risk Pools For Uninsurable Individuals

Figure 1: Concentration of Health Care Spending in U.S. Population, 2011

In the debate over the future of the Affordable Care Act (ACA), proposals have emerged that would repeal or weaken rules prohibiting health insurance discrimination based on health status, instead offering high-risk pools as a source of coverage for people who would be uninsurable due to pre-existing conditions.

In Congress, HR 2653 was introduced by members of the House Republican Study Committee to repeal the ACA and replace it with other changes, including state high-risk pools.  This bill would authorize $50 million for seed grants to help states establish high-risk pools, and $2.5 billion annually for 10 years to help states fund high-risk pools.  Recently, House Republicans released their proposal to replace the ACA, entitled A Better Way.  This plan would significantly modify ACA insurance market rules to provide a one-time open enrollment opportunity; thereafter, only individuals who maintain continuous coverage would be guaranteed access to insurance without regard to their health status.  This plan also would provide $25 billion over 10 years in state grants to help fund high-risk pools.  Pools would be required to cap premiums (at unspecified levels) and would be prohibited from imposing waiting lists.

For more than 35 years, many states operated high-risk pool programs to offer non-group health coverage to uninsurable residents.  The federal government also operated a temporary high-risk pool program established under the ACA to provide coverage to people with pre-existing conditions in advance of when broader insurance market changes took effect in 2014.  This issue brief reviews the history of these programs to provide context for some of the potential benefits and challenges of a high-risk pool.

Explaining Health Care Reform: Risk Adjustment, Reinsurance, and Risk Corridors

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Explaining Health Care Reform: Risk Adjustment, Reinsurance, and Risk Corridors

Figure 1: Risk Adjustment Under the Affordable Care Act

As of January 1, 2014, insurers are no longer able to deny coverage or charge higher premiums based on preexisting conditions (under rules referred to as guaranteed issue and modified community rating, respectively). These aspects of the Affordable Care Act (ACA) – along with tax credits for low and middle income people buying insurance on their own in new health insurance marketplaces – make it easier for people with preexisting conditions to gain insurance coverage. However, if not accompanied by other regulatory measures, these provisions could have unintended consequences for the insurance market. Namely, insurers may try to compete by avoiding sicker enrollees rather than by providing the best value to consumers. In addition, in the early years of market reform insurers faced uncertainty as to how to price coverage as new people (including those previously considered “uninsurable”) gained coverage, potentially leading to premium volatility. This brief explains three provisions of the ACA – risk adjustment, reinsurance, and risk corridors – that were intended to promote insurer competition on the basis of quality and value and promote insurance market stability, particularly in the early years of reform.

CONCLUSION

The Affordable Care Act’s risk adjustment, reinsurance, and risk corridors programs were designed to work together to mitigate the potential effects of adverse selection and risk selection. All three programs aimed to provide stability in the early years of a reformed health insurance market, with risk adjustment continuing over the long-term. Many health insurance plans are subject to more than one premium stabilization program, and while the programs have similar goals, they are designed to be complementary. Specifically, risk adjustment is designed to mitigate any incentives for plans to attract healthier individuals and compensate those that enroll a disproportionately sick population. Risk corridors were intended to reduce overall financial uncertainty for insurers, though they largely did not fulfill that goal following congressional changes to the program. Reinsurance compensated plans for their high-cost enrollees, and by the nature of its financing provided a subsidy for individual market premiums generally over a three-year period. Premium increases are expected to be higher in 2017 in part due to the end of the reinsurance program.

Campaign 2016 Healthcare Election Issues

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http://connect.kff.org/poll-health-care-issues-in-the-2016-elections-the-publics-views-on-zika-and-electronic-medical-records?ecid=ACsprvsNwVqzoYoktjeMadLmMP_j5z4aIEIDLtV7mAYMiD8KEFvV0TCbNnPbhhL1Z-Bec8iS2pPQ&utm_campaign=KFF-2016-August-Tracking-Poll&utm_source=hs_email&utm_medium=email&utm_content=33682024&_hsenc=p2ANqtz-8xtyy8YqJQ7WAY3Hy2-UCQDhQKjYlvB05qHdtEnzbB4uaWO2JZQtkeD0o1C6GXU8BopN7QM81MUjiM3NFIn_7Xlb8t-A&_hsmi=33682024

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Two thirds of voters (66%), including large shares of Democrats, Republicans, and independents, identify access and affordability of health care and the future of Medicare, an issue not being widely discussed on the campaign trail, as top priorities for the presidential candidates to talk about during the campaign. Smaller majorities of voters say the same about Medicaid’s future (54%), prescription drug costs (53%), and the future of the 2010 health care law (52%).

 

Will Medicare Premium Increases Be an Issue in November?

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http://blogs.wsj.com/washwire/2016/06/22/will-medicare-premium-increases-be-an-issue-in-november/

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Buried in the Medicare trustees report released Wednesday are a few lines that could cause political controversy. “In 2017 there may be a substantial increase in the Part B premium rate for some beneficiaries,” the actuaries write—which means seniors will find out about increases shortly before Election Day.

Higher-than-expected Medicare spending in 2014 and 2015 set the stage for a large premium adjustment in 2016. But, notably, the absence of inflation thanks to the drop in energy prices last year meant that seniors receiving Social Security benefits did not receive an annual cost-of-living adjustment.

The Medicare statute has a “hold harmless” provision that prevents Part B premiums from rising by more than the amount of a Social Security cost-of-living adjustment. For most beneficiaries, the provision meant that in 2016, they received no such adjustment—but also did not pay a higher Part B premium. However, nearly one-third of beneficiaries—new Medicare enrollees, “dual eligibles” enrolled in both Medicare and Medicaid (in places where state Medicaid programs pay the Medicare Part B premium), and wealthy seniors subject to Medicare means-testing—do not qualify for the provision.

The New York Times noted last fall that the hold-harmless provision, by protecting most beneficiaries, exposed some to higher increases: “If premiums are frozen for 70 percent of beneficiaries, premiums for the other 30 percent must be raised more to cover the expected increase in overall Medicare costs. In other words … the higher Medicare costs must be spread across a smaller group of people.”

The Next Big Debate in Health Care

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http://blogs.wsj.com/washwire/2016/06/30/the-next-big-debate-in-health-care/

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Source: Kaiser Family Foundation analysis of Truven Health Analytics Market Scan Commercial Claims and Encounters Database, 2004-2014; Bureau of Labor Statistics, Seasonally Adjusted Data from the Current Employment Statistics Survey, 2004-2014 (April to April).

With 91% of the population now covered by some form of health insurance, and the coverage rate higher in some states, the next big debate in health policy could be about the adequacy of coverage. That particularly means rising payments for deductibles and their impact on family budgets and access to care. This is about not just Obamacare but also the many more people who get insurance through an employer.

As the chart above shows, payments toward deductibles by consumers who have insurance through large employers rose 256% from 2004 to 2014; over the same period, wages increased 32%. The chart shows what people actually paid toward their deductibles and other forms of cost-sharing, not just their exposure as deductibles climbed (which is more typically what studies and data report). Deductibles accounted for 47% of cost-sharing payments in 2014, up from 24% in 2004. During the same period some other forms of cost-sharing fell. Payments for co-pays declined by 26%. It’s no wonder that consumers say in polls that deductibles are their top health-cost concern.

Rising payments for deductibles cause people to use less health care and have played a role in the moderation we have seen in recent years in the growth of health spending. That rate of growth has begun to tick up but remains moderate by historical standards. Ever larger deductibles may dampen growth in spending but can also be a significant burden for many family budgets and a barrier to care for the chronically ill.

Will House Republican Health Proposal and Trustees’ Report Make Medicare a Factor in Election?

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http://blogs.wsj.com/washwire/2016/06/24/will-house-republican-health-proposal-and-trustees-report-make-medicare-a-factor-in-election/

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So far Medicare has not been one of the major health-care issues in the presidential campaign. Neither Hillary Clinton nor Donald Trump has talked about it much. The former secretary of state has discussed the idea of a Medicare buy-in for the near-elderly, but that’s been mentioned more as a way of strengthening the Affordable Care Act, not reforming Medicare. Meanwhile, Medicare faces serious long-term challenges, including how to finance care for an aging population, ensure its solvency in the future, fill gaps in coverage, and address cost-sharing burdens that can be onerous for its mostly lower- and moderate-income beneficiaries.

New Commonwealth Fund Report: Latinos and People with Low Incomes Are Most Likely to Be Uninsured, Despite Significant Gains Under Affordable Care Act

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http://www.commonwealthfund.org/publications/press-releases/2016/aug/remaining-uninsured

Latinos Are a Growing Share of the Uninsured

Of the U.S. adult population currently without health insurance, 88 percent is Latino, makes less than $16, 243 a year, is under age 35, and/or works for a small business, according to new Commonwealth Fund survey findings. Half (51%) of the remaining uninsured live in one of the 20 states that had not yet expanded Medicaid at the time of the survey.

The report, Who Are the Remaining Uninsured and Why Haven’t They Signed Up for Coverage?, finds that an estimated 24 million working-age adults were uninsured between February and April 2016, six years after the initial implementation of the Affordable Care Act (ACA) in 2010. According to the report, as the number of people without health insurance declined by 20 million since the law went into effect, the composition of the uninsured population has changed: white adults now represent a smaller share and Latinos a larger share.

“About 26 million Americans have gained coverage through the Affordable Care Act’s marketplaces and Medicaid expansion,” said Sara Collins, Vice President for Health Care Coverage and Access at The Commonwealth Fund and the report’s lead author. “However, millions of people still don’t have health insurance. That means they are likely to go without the health care they need and are at risk of medical debt or bankruptcy if they get sick.”

The study finds that state and federal policies, varying levels of awareness about the health insurance marketplaces, and concerns about affordability are the primary reasons people remained uninsured.